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States mentioned other varied Medicaid program priorities, in addition to navigating state budget challenges and implementing H.R.1 provisions , including: expanding access , especially behavioral health and long-term care, often through payment rate reviews and reimbursement reform implementing initiatives that target specific populations , including pregnant individuals, justice-involved, and people experiencing or at risk of homelessness continuing delivery systems efforts , including strengthening managed care performance and oversight and implementing value-based payment models improving administrative systems / functions , including large-scale efforts to modernize IT infrastructure and expanding program integrity efforts Methods KFF commissioned Health Management Associates (HMA) to survey Medicaid directors in all 50 states and the District of Columbia to identify and track trends in Medicaid spending, enrollment, and policy making